Hamman's crunch: a forgotten clue to the diagnosis of spontaneous pneumomediastinum.

BMJ Case Rep

Departamento de Medicina Interna e Medicina Intensiva, Hospital da Luz Lisboa, Lisboa, Portugal.

Published: April 2018

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893969PMC
http://dx.doi.org/10.1136/bcr-2018-225099DOI Listing

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Article Synopsis
  • - Hamman's syndrome is a rare complication of diabetic ketoacidosis (DKA) that causes subcutaneous emphysema and spontaneous pneumomediastinum, as demonstrated in a case involving an 11-year-old boy with newly diagnosed type 1 diabetes.
  • - The patient showed classic DKA symptoms like excessive thirst, frequent urination, abdominal pain, and fatigue and was initially treated with IV fluids and insulin before being transferred to a specialized children's hospital.
  • - Upon examination, he showed signs of Hamman's syndrome, which was resolved with conservative treatment, emphasizing the need for awareness of this condition in pediatric DKA cases to ensure proper diagnosis and management.
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Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population.

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Spontaneous Pneumomediastinum (SPM) is a benign, self-limiting but potentially fatal condition specially in underlying pulmonary disease. Spontaneous pneumomediastinum is rarely associated with connective tissue related interstitial lung disease. We report a patient of interstitial pneumonia with autoimmune features who presented with acute onset breathlessness and was diagnosed to have spontaneous pneumomediastinum, pneumopericardium, and subcutaneous emphysema.

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Pneumomediastinum is defined as the presence of air in the mediastinum. Trauma to the nearby organs can cause air to escape into surrounding tissues that may manifest clinically as severe chest pain, voice change, or shortness of breath. However, pneumomediastinum can present spontaneously in healthy individuals with no inciting factors in which case the condition is termed spontaneous pneumomediastinum (SPM).

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Reported here is a rare respiratory complication in a young primiparous woman in a remote community hospital in the Northern Territory, Australia. A Caucasian primiparous woman aged 23 years presented with chest pain following a very prolonged second stage of labour. On clinical examination a crunching and crackling sound was heard over the precordium, synchronous with the heartbeat (Hamman's sign).

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